Managed Medicaid

Colo. Access Joins State, CHCS In New Medicaid Pilot Program

Reprinted from the 2/21/08 issue of MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

Colorado Access, once the largest Medicaid managed care plan in the state, has spent the past few years building its presence in the Medicare Advantage program from a single Special Needs Plan (SNP) for people dually eligible for Medicare and Medicaid into an array of five MA products for 2008. But Colorado Access said when it exited Colorado's Medicaid managed care program in August 2006 that it would look for opportunities to return, and it will do so soon under a pilot program for Medicaid recipients who are elderly or disabled, company and state officials tell MAN.

Called the Colorado Integrated Regional Care Collaborative, the two-year pilot program is a partnership of local health plans and providers, the Colorado Dept. of Health Care Policy Financing, consumer organizations and the Center for Health Care Strategies (CHCS). Colorado is one of several states to participate in the national collaborative, sponsored by CHCS. In Colorado, state officials say the program will aim to improve the quality of care for Colorado Medicaid's highest-need, highest-cost recipients through better coordination of their now-fragmented physical-health, mental-health and substance-abuse services.

Nonprofit Colorado Access is the first health plan to join the program, which is open to Medicaid recipients aged 21 or older who are in the Aid to the Needy Disabled/Aid to the Blind (AND/AB-SSI) and Old Age Pensioners — Under Age 65 (OAP-B) eligibility groups. Colorado Access will offer intensive care management, care coordination and supplemental benefits in six counties in the Denver metropolitan area, state officials say.

"We expect to see our first enrollment early this summer," Gretchen Flanders McGinnis, director of strategic planning and network development for Colorado Access, tells MAN. "Our expectation and the state's expectation is getting more of the Medicaid population into a managed care setting by 2010….The state has made it clear they want to reinvigorate the Medicaid managed care environment in Colorado, which we're very pleased about."

Christy Hunter, a quality compliance specialist with the Colorado Dept. of Health Care Policy and Financing, explains that the state was approached by CHCS about joining the initiative, and decided to focus on Colorado's adult disabled population and people aged 60 to 64 with Medicaid coverage. She says the state held a stakeholders' meeting on the pilot program Feb. 14.

Kaiser Permanente May Also Participate

According to state officials, the program could expand well beyond Colorado Access. "We're also looking to contract with Kaiser [Permanente's Colorado Region] and others to make the program more statewide," says department spokeswoman Joanne Lindsay. Lindsay describes the state as being "in the early stages of discussion" with Kaiser, which continues to manage a State Children's Health Insurance Program (SCHIP) population of 3,600 that the state considers part of its Medicaid Primary Care Case Management (PCCM) program. Kaiser officials did not return calls for comment by MAN's press time.

Under the Medicaid pilot program, Lindsay says, "The minimum enrollment we want to achieve is 2,500 with Colorado Access, but we're hoping for closer to 6,000 by the end of the year [i.e., 2008]."

While the state's main goal is to improve high-need Medicaid recipients' coordination of care, cost savings also are anticipated from the new program, Hunter says. "Colorado Access will be a full-risk MCO [i.e., managed care organization] contract. If we do move forward with Kaiser, that will likely be a full-risk contract…and Kaiser would include all Medicaid eligibles, not just the disabled," she says. The state envisions a long-term goal of 30,000 to 40,000 Medicaid recipients enrolled in Kaiser several years out, with the effort likely to start at the end of 2008 or early 2009, Hunter says. "But we are focusing first on the Colorado Access pilot and evaluating it before we expand in any way," she says.

Reasons Behind Colo. Access Departure

Two years ago, Colorado Access was the largest Medicaid managed care plan in Colorado, with about 65,000 people enrolled for physical health benefits. But Colorado Access announced in July 2006 that it was exiting Colorado's Medicaid program effective Aug. 31, 2006, after the state said payment rates would decrease by as much as 15%.

Colorado Access became the first Medicaid-focused plan in the U.S. to enter the MA program with a SNP for dual eligibles in February 2005. That zero-premium plan is part of a Colorado Access Advantage portfolio that includes a behavioral-health SNP for people with serious and persistent mental illness; another chronic-care SNP for people with diabetes, congestive heart failure, cardiovascular disease or chronic obstructive pulmonary disease; and two MA prescription drug plan (MA-PD) HMO products for 2008.

Colorado Access Advantage gained a 5% to 6% increase in its MA plans from Dec. 31, 2007, through the end of January, and now has about 2,500 total MA members, McGinnis says. While the bulk of enrollment is in the dual SNP, there is some membership in all four of the new MA plans, she says. "For this year, we're expecting enrollment to be 500 to 1,000 [new] members going into any one of those five plans," says Sharon Steadman, executive director for Colorado Access Advantage. Steadman notes that the dual SNP has an expanded dental benefit for 2008 — $1,000 comprehensive dental coverage this year versus a $750 annual preventive dental coverage previously — "because we're finding a lot of unmet dental needs."

Advertise With AIS

Privacy

Site Map